Intrauterine adhesion is a more prevalent finding at hysteroscopy than submucous fibroid or polyps among infertile sub-Sahara African Women presenting for In-vitro Fertilization who have had previous uterine surgical procedures: A 15-year study

Abstract

Introduction: Hysteroscopy assists in detecting any intra-uterine anomaly among subfertile women who present for Assisted Reproductive Technology (ART). Previous uterine surgical procedures may have influence over these hysteroscopic findings. Objective: To determine which specific previous uterine surgical procedure was likely to have deleterious hysteroscopic findings and how much more likely. Methodology: This was a retrospective study in which case records of 1631 women who presented for ART from 2003 to 2018 were examined. Only Black African women with complete records and who presented solely for fertility management were included. Analysis was conducted with STATA 13 statistical software. Results: The means of age (years) and BMI (Kg/m2) were 38.7 (6.4) and 28.1 (5.3) respectively. Of the 1631 study subjects, 1574 (96.5%) were ever married, 690 (42.3%) were professionals and 462 (28.3%) were <35 years old while 1169 (71.7%) were ≥35 years. Those who never had uterine surgery (n=276, 16.9%) were significantly younger (t-test=5.10, P-value=0.0000001) than those who had had uterine surgery (n=1355, 83.1%). There was a significant variation (t=-4.32, P-value=0.0000001) in the mean duration of subfertility (years) among women who had no uterine surgery (5.9±5.0) and those who did (7.4±5.3). Depth of uterine cavity was significantly greater (t=-3.54, P-value=0.0002) among women who had undergone uterine surgery (n=1355, 83.1%) than among those who had never undergone uterine surgery (n=276, 16.9%). Sub-fertile women who had undergone various uterine surgeries (n=200, 14.8%) were 4.7 times more likely to present with intrauterine adhesions (IUA) (χ²=51.6, P-value=0.0.0000001, OR=4.73, 95% CI: 2.99, 7.50), 1.89 times more likely to present with polyps at hysteroscopy compared with women who had not undergone surgeries (χ²=14.55, P-value=0.0.001, OR=1.89, 95% CI: 1.36, 2.64). Intrauterine adhesion was most prevalent (41.8%) among women who had pre-hysteroscopic D&C and myomectomy (χ²=82.84, P-value=0.0000001) and among those who had multiple prehysteroscopic surgical procedures such as D&C, C/S and Myomectomy. Conclusion: Pre-hysteroscopy IUA was most prevalent among sub-fertile women presenting for management of infertility, especially among those who had undergone three previous uterine surgical procedures of D&C, C/S and myomectomy than those who had undergone D&C and Myomectomy and least among those who had had Myomectomy and C/S. IUA was least prevalent among those who had C/S alone. These findings underscore the importance of past history of uterine surgical procedures and of hysteroscopy among those presenting for fertility management.